ORIGINAL ARTICLES

A balanced colonisation by endogenous vaginal microflora of the lower female genital tract consists of predominantly Lactobacillus species,1 co-existing with vaginal anaerobes and aerobes such as Streptococcus agalactiae (e.g. group B streptococci)2 and the Bacteroides family.3 Disturbing this microbial milieu results in overgrowth of bacterial vaginosis-related organisms which are associated with a 3- 6 times greater risk of postpartum endometritis.4,5 However, the role of endogenous lower genital tract pathogens, especially bacterial vaginosis organisms, and their impact on postpartum infectious morbidity, is controversial.6,7 Other vaginal organisms associated with postpartum infectious morbidity include Ureaplasma urealyticum, group B streptococcus (GBS) and other sexually transmitted infections (STIs) such as Trichomonas vaginalis, Neisseria gonorrhoeae and Chlamydia trachomatis. Case detection and treatment of the latter STIs is often technically difficult and expensive. Furthermore, the prevalence of genital tract infections is probably higher among HIV-positive women because of their associated immunosuppression. Studies have shown perturbations in the vaginal flora of HIV-infected women, with approximately 20 % of HIV-infected women having Lactobacillus-dominant vaginal flora.8,9 Cu-Uvin et al. found no difference in the prevalence rates of Corresponding author: J Moodle